Development and effects of an emotional recognition memory training program on social cognition in children with Autism Spectrum Disorder

Abstract

Background: Children with autism spectrum disorder (ASD) have difficulty recognizing facial expressions, tone of voice, body language, and context. Emotional arousal and emotion recognition (required emotional empathy and cognitive processing empathy) induce downstream illnesses in these children, which consequently impair their occupational performance in terms of social involvement and peer interaction. Objectives: First, we aimed to review the efficacy of emotional recognition training on social cognitive abilities in children with ASD. Second, we aimed to develop and validate an emotional recognition memory training program (ERMTP) and conduct a pilot test of the ERMTP with both normally developing children and those with ASD. Finally, we aimed to determine the effectiveness of the ERMTP in improving social cognition among children with ASD. Materials and methods: This study comprised three phases. The first phase, the literature review, was conducted to determine the impact of emotion recognition training on social cognition in children with ASD. In the second phase, an ERMTP with two tasks was designed. The content of task 1 (two activities) and task 2 (nine activities) was validated by five experts. A pilot test was conducted to identify the responses of five typically developing children and five children with ASD when using 2 weeks of the ERMTP intervention. During the third phase, the effects of the ERMTP on the social cognitive abilities of the children with ASD were examined. A control group (n = 20) and an ERMRP group (n = 20) were randomly assigned using a sample of 40 children with ASD. The children participated in the ERMTP six days per week for four weeks, with 24 sessions of 60 minutes each. The CARS, CMQ-R, OMQ-PF, and SRS were evaluated pragmatically pre-, post and 1 month following the treatment. Results: In phase 1 and 2, the development of ERMTP activity items showed good content validity, especially regarding clarity and relevance. All five content experts gave the intervention an IOC of 1.0 for its distinct components. The descriptive analysis indicated that all ten children (5 typically developing and 5 children with ASD) followed the emotional expressions and instructions (100%), and all parents reported changes in the children’s focus and memory skills. In a pilot test, a comparison of pre- and post-ERMTP of the social cognitive index showed there was significant change (Z = - 2. 023, p = .043) in children with ASD (n=5). In phase 3, pairwise comparisons of the experimental groups were conducted pre- and post-intervention and post-follow-up. There were changes in the estimated marginal means of all the social cognition variables, emotion regulation, and memory skills. In particular, the pre-and post-tests revealed statistically significant differences in the social cognitive index (t = 7.060, p = 0.001), memory function (t = 12.369, p = 0.001), emotion regulation of imitation (t = 2.650, p = 0.016), and emotional responses (t = 2.364, p = 0.030). Furthermore, at the 1-month follow-up, there were statistically significant differences in the social cognitive index (t = 2.126, p = 0.048), emotional response (t = 2.191, p = 0.042), QMQ-PF total score (t = - 2.650, p = 0.016), episodic memory (t = 2.260, p = 0 .036), and CMQ total score (t = 3.274, p = 0.004). Conclusion: The children with ASD showed a statistically significant improvement in social cognition skills following the ERMTP. This intervention is helpful for occupational therapists and parents of children with ASD.